A BRIEFING from CCPS, SFHA and EVOC

4

CITY OF EDINBURGH COUNCIL:
CONTRACTS FOR CARE AND SUPPORT SERVICES

A BRIEFING FROM CCPS, SFHA and EVOC

CCPS is the association for care and support service providers in Scotland’s voluntary sector. Supported by the Scottish Federation of Housing Associations and the Edinburgh Voluntary Organisations Council, we are leading a national debate on competitive tendering in care and support services. We have gathered and produced a range of information and evidence about the risks and the impact of service re-tendering[1] and would like to draw these to the attention of councillors prior to the council meeting on 19th November, at which council will be asked to approve contract award recommendations.

CCPS, SFHA and EVOC include among their membership a number of those organisations recommended for contract award, as well as many of the existing service providers whose services stand to be transferred. In preparing this briefing, we are not attempting to represent or promote any of those organisations in relation to this particular tender either jointly or individually, or otherwise to act on their behalf: rather, we are keen to share with councillors the experience of all those voluntary organisations and housing associations that have been involved in the dozens of re-tendering exercises that have already taken place across Scotland.

CHOICE, CONTROL AND DIRECT PAYMENTS

A key policy objective in social care is to increase the level of choice and control that individuals are able to exercise in relation to their support. The requirements placed on social care professionals in this regard are set out quite clearly both in the National Care Standards published by Scottish Ministers and in the Codes of Conduct for social services workers and employers published by the Scottish Social Services Council.

In Edinburgh, well over 600 people currently receiving a service stand to have that service transferred from their existing provider to a new organisation. Very few (if any) have been able to exercise choice in this regard. The impact of a change of service provider on individuals and families who have not been involved in decision-making can be profound. In 2008, CCPS supported the production of a short film featuring the views of those affected by re-tendering in various parts of Scotland. Councillors may wish to view this film on YouTube at the following link: http://www.youtube.com/watch?v=Z9_pprG77sY.[2]

Many people in Edinburgh affected by this tender have a relationship with their current provider that goes back 10, 20 years or more, and the impact of an imposed change of provider on people who are already facing considerable challenges in their lives should be not be underestimated.[3] This is recognised in government guidance emphasising the importance of maintaining continuity of care for vulnerable groups.[4]

One of the ways in which individuals can be enabled to choose who provides their support is through a Direct Payment. We understand that whereas council officials had initially suspended the processing of applications for Direct Payments in relation to this tender pending contract award and service transfer, they are now willing to process all outstanding applications for Direct Payments, and indeed to offer this option to all those people whose support has been subject to this tender.

This is very welcome. There is however likely to be a very large group of people – perhaps even the majority of the 770 people affected by this tender – who either do not feel able to manage a Direct Payment, or who are likely to be assessed as ineligible for one because of a lack of capacity. The potential impact of service transfer on this group will be as significant as it is for those who are able to access a Direct Payment, and we would urge you to ensure that choices and options are also available to those who either cannot manage or cannot have a Direct Payment.

It is also important that the rate payable under a Direct Payment is sufficient to enable individuals to make a meaningful choice. We are concerned that the Direct Payment rates now published by the council may not enable everyone who wants to do so, to remain with their existing provider, since cost reductions of this order will almost certainly involve cuts to the terms and conditions of support staff which cannot be achieved in the short term (and which may in any case result, in our view, in a deterioration in service quality). We are particularly concerned that these rates will not be sufficient to enable an individual to choose a service provided by the council’s own in-house care and support team, which is an option that should be available to them under legislation.

SERVICE QUALITY

The report to be put before councillors by officials on 19th November states that the first ‘specific objective’ of this procurement exercise is that of ‘improving quality of service to customers.’

National, independent and objective information on service quality in this field is published by the Care Commission, the statutory authority for the regulation and inspection of care services. Since April 2008, the Care Commission has required service providers to conduct a quality self-evaluation in respect of all registered services: the inspection process then tests key elements of that self-evaluation and awards the service a series of gradings for various aspects of service quality (including quality of care and support, quality of staffing and quality of management and leadership) running from a grading of 1 (unsatisfactory) to 6 (excellent). Gradings at the higher end of the scale cannot be achieved without significant levels of involvement and participation in the self-evaluation exercise by people receiving the service.

According to data available on the Care Commission’s public website, the vast majority of existing voluntary sector care and support services in Edinburgh that are subject to this tender have been graded by the regulator as 4 (good), 5 (very good) and 6 (excellent), with most at gradings 5 and 6. Under the contract award recommendations now proposed to the council, a number of these services stand to be transferred to new providers, including private companies that have comparatively poor gradings records[5]. Under the circumstances, we would urge councillors to satisfy themselves that service quality will not suffer as a result of this re-tendering.

TUPE AND WORKFORCE ISSUES

In this tender, the total number of service providers is set to be reduced from over 30 to just eight. The number of voluntary sector organisations providing services will be reduced from more than 20 to just four. The providers recommended for contract award are therefore likely to have to enter into multiple TUPE arrangements with a range of separate and independent organisations, each of which will have its own set of terms and conditions. Again, providers’ experience of TUPE has been overwhelmingly negative, and the impact both on the transferring workforce and on those managing the process is considerable. Recently-published independent academic research evidence bears this out.[6]

We have made enquiries among our member providers and we estimate that over 250 staff currently work in voluntary sector services affected by this tender. Few of the organisations recommended for contract award (and none of the private companies) appear to have sought information from existing service providers about the potential costs that will arise for them should TUPE apply, indicating that there may be significant doubt as to even the short-term viability of services within the prices submitted by some of the successful bidders in this exercise. Given that staff costs typically make up more than 80% of the hourly rate for this type of service, we believe that there may also be significant doubt about the reliability of the projected figure of 21% cost savings set out in the report to council for 19th November.

We understand that previous tendering exercises conducted by the City of Edinburgh Council have run into some very significant problems in respect of TUPE, and that in at least one instance, TUPE issues may have led to the collapse of the contract award process. The contract awards that councillors are being asked to approve on November 19th are likely to lead to a series of service transfers that will dwarf any service transfer programme dealt with by any other council in Scotland to date.

THE IMPACT OF SERVICE TRANSFERS ON THE MARKET

Service providers that have managed large-scale service transfers following re-tendering have found them to be costly, disruptive, labour-intensiveand a cause of very significant anxiety for people who use services, their families, and the staff who provide their support. Dealing with transfers takes months of senior management time, energy and effort. Routine re-tendering of contracts on a three-year cycle, as we understand is planned in Edinburgh, is likely to cause significant damage to the market and consume scarce resources which we believe would be much better spent on service delivery.

It is a cause of particular concern in relation to this tender that services to people with mental health problems currently provided by specialist organisations stand to be transferred in some cases to organisations with no track record in this field and no apparent links to current Scottish Government mental health policy, including the important developing agenda on recovery. If the contract awards are approved as recommended, there will be no specialist mental health organizations remaining in Edinburgh as providers of care at home or housing support for people with mental health problems. Referring back to our remarks on service quality, it is very difficult to see how quality improvement will come about under these circumstances.

______

In preparing this briefing, we are very much aware that the precise nature and scale of the service transfers that may result from contract award are not yet in the public domain: we have tried in this communication to set out what the council’s own documentation suggests will be the case, although we accept that the detail may not be borne out in all respects by more up to date information. Nevertheless, we believe that the general thrust of the key issues we have raised remains critical, even though the actual numbers involved may change. Under the circumstances we would urge councillors to satisfy themselves on the detail of these points before approving the contract award recommendations.

Finally, we would want councillors and officials alike to understand that we appreciate the financial pressures facing local government in general and care services in particular.
We also appreciate that competitive tendering can, when handled appropriately, contribute to councils’ responses to these pressures. However having led the debate in this area and produced a series of important survey and research evidence in relation to it, we feel obliged to highlight the potentially very serious negative consequences of the council’s actions on this occasion.

17 November 2009

4

CCPS
9 Ellersly Road
EDINBURGH
EH12 6HY
T: 0131 337 3295
E:
W: www.ccpscotland.org

SFHA
375 West George Street
GLASGOW
G2 4LW
T: 0141 332 8113

E:
W: www.sfha.co.uk

EVOC
14 Ashley Place
EDINBURGH
EH6 5PX
T: 0131 555 9100

E:
W: www.evoc.org.uk

4

[1] Competitive tendering in social care and support services: a position statement, CCPS 2007; Re-tendering of social care services: service providers’ perspectives, CCPS 2008

[2] My life is not a three-year contract, DVD produced by Sense Scotland for the CCPS Conference 2008

[3]Please note that CCPS does not advocate the automatic renewal of care contracts regardless of issues of cost or quality: however we do believe that competitive challenge should be triggered primarily by poor performance, and that people using services should be involved in the assessment of performance.

[4]“Contracting authorities should…aim to strike a reasonable balance between legal requirements to competitively tender contract opportunities and the need to manage competitions effectively while ensuring that quality and continuity of service is not adversely affected”, Scottish Procurement Policy Note SPPN 10/2008: social care procurement: advertising and competition, Scottish Procurement Directorate August 2008

[5] According to Care Commission figures, the 10 voluntary sector providers with the largest volume of existing services subject to this tender – none of whom have been recommended for contract award - have all achieved ‘positive’ gradings for quality of care and support in 2009 (ie. ‘good’, ‘very good’ or ‘excellent’), with the majority in the ‘very good’ or ‘excellent’ category. By contrast, two of the incoming private companies recommended for contract award have only attained ‘adequate’ in the majority of comparable services that they provide elsewhere in Scotland. No private company has attained a grading of ‘excellent’ in the most recent round of inspections, and none has achieve a grading of ‘very good’ in all its services, compared to at least nine of the existing providers whose services stand to be transferred.

[6] A Gathering Storm? Procurement, re-tendering and the voluntary sector social care workforce, University of Strathclyde SCER with the Voluntary Sector Social Services Workforce Unit, 2009